Organ Donation: Heaven Knows We Need Them Here!
Organ donation is not a controversial issue. Nonetheless, it's a crucial issue that demands our attention. Further, it's one that everyone can resolve in a matter of minutes. No letters to Congress. No hours to volunteer. Not even a check to write. All it needs is your signature and a conversation with your family. For some, however, it will necessitate a profound shift in the Jewish way you have viewed this issue.
Robert Test, an ordained minister and change consultant, wrote the following text:
The day will come when my body will lie upon a white sheet [...] in a hospital [...,] a doctor [having] determine[d] that my brain has ceased to function and that [...] my life has stopped. When that happens, do not [...] call this my deathbed. Let it be called the Bed of Life, and let my body be taken from it to help others lead fuller lives. Give my sight to the man who has never seen a sunrise, a baby's face, or love in the eyes of a woman. Give my heart to a person whose own heart has caused nothing but endless days of pain. Give my blood to the teenager who was pulled from the wreckage of his car, so that he might live to see his grandchildren play. Give my kidneys to one who depends on a machine to exist from week to week. Take my bones, every muscle, every fiber and nerve in my body and find a way to help a [disabled] child walk. Take my cells if necessary, and let them grow so that someday a speechless boy will shout at the crack of a bat and a deaf girl will hear the sound of rain against her window. If [...] you do all I have asked, I will live forever. 1
Sharing our lives with those less fortunate than ourselves is a noble value by which most of us strive to live. We give our money, our food and our time to reach out and help those who simply cannot make it on their own, whether because of poverty, age or illness. And yet, Test's words remind us it is possible to share life with others even after life is no longer ours. When we have died and are finished with the body that has been given to us for our stay on this earth, we possess an opportunity to make a precious gift that can be moved into someone else's body and provide that person with the gift of life when they might otherwise die.
Even in times of tragedy - where, far too soon, death has claimed the life of one we love - organ donation offers the possibility to honor someone we love, even extending that love so that someone else might benefit from the goodness that was a vital part of the relationship we shared. Through the gift of organ and tissue donation, our love is enlarged, and the circle of our love widened.
The only problem is that so many of us don't do it. We don't sign our donor cards, and we don't give permission for tissues to be taken from our loved ones who have died. Granted, it's part of a larger problem; namely, that while nearly 30,000 transplants are performed each year, there are more than 100,000 candidates waiting in line. But within our own Jewish community - a community that every one of us knows is intensely committed to values of tzedakah and gemilut hasadim, acts of justice and human compassion - we lag behind nearly every other cultural and religious group in both the signing of donor cards and actual organ donation.
According to an article in Moment magazine,2 in the wider community objections to organ donation include "misconceptions that the donating process will [disfigure] a loved one's body" and "an erroneous but persistent belief that the donor's family will be charged for the procedure. [...] Others," Moment adds, "are simply unaware of their loved one's desires to become a donor."
The Jewish community is another matter. Because we carry within us the collective memories of our people's journey through Jewish history, we often recall biblical and rabbinic teachings that either obligate or forbid us from doing something. And regardless of our general level of ritual observance, we sometimes live by these memories as if they constitute religious law. So on the basis of these teachings, we come to hear the shofar on Rosh HaShanah, atone for our sins on Yom Kippur, refrain from eating leavened foods on Pesach, and insist that Jews are forbidden from donating body organs and tissues. These perceptions, by the way, cut clear across denominational lines. Orthodox Jews will not sign donor cards. Conservative Jews will not sign donor cards. Reconstructionist Jews will not sign donor cards. And Reform Jews will not sign donor cards.
As a result, we have stories like this one: An Israeli family flew with their daughter to the United States for a liver transplant. While in the air, although she was under constant expert medical care, the girl died. The medical team that had been called into duty to provide the girl with a lifesaving transplant later turned to her family and asked if they would now donate her remaining healthy organs to possibly save other lives. The family deeply apologized, expressed their concern for the other individuals, but insisted that it's just not permitted under Jewish law.
Jewish law does, in fact, permit organ donation! Whatever you have heard, whatever you thought you learned, set that all aside. Jewish law permits us to sign our donor cards and, when someone we love dies, to use their body to save other lives.
Why then the persistent misperception that Jewish law opposes organ donation? There are four legal concerns Judaism confronts in determining whether or not to permit organ donation. Each concern, on the surface, appears to take a position of opposition. This is probably why so many of us conclude - even as Reform Jews - that we cannot sign donor cards. But follow the discussions to their conclusions and you will understand that, even among Orthodox Jews, organ donation is permissible.
The first area of concern is how one treats the body of someone who has died. Judaism views the human being in life as having been created b'tzelem Elohim ... in the image of God. This means that, while we live, we are forbidden from doing anything to harm our, or anyone else's, body. We are not to abuse drugs or alcohol, overeat, receive tattoos, or murder. When the body dies, we continue to treat it with utmost respect, what we call k'vod ha'met ... honoring the dead. We bury loved ones as soon as we can, and we take extra care of their bodies until they are interred in their final resting places.
The Torah makes it clear that we must bury our dead without delay (within a day, if possible).3 The Talmud confirms this obligation, 4 but provides a number of reasons why burial might be put off for a short time. These include obtaining the appropriate burial materials and waiting for family members who are coming from far away. Too often, we assume that medical autopsies do not constitute a justifiable delay of burial. The truth is, however, that the Torah, the Talmud, nor the Shulkhan Arukh (the authoritative traditional compendium of Jewish law) makes any mention of autopsy being forbidden. In fact, one is able to find in the Talmud5 evidence of the rabbis themselves having participated in autopsies to learn about the structure of the human body.
Does it desecrate the human body to make incisions in it after a person has died? The Talmud makes it clear6 that to do so unnecessarily and for no good purpose would violate the principle of k'vod ha'met, honoring the dead. But if such a post-mortem examination might save a life, the Talmud teaches us that we should indeed examine that body by all means available.
So if we thought that Jewish tradition opposes organ donation because of unnecessary delay to the burial or disrespectful treatment of the body, we now know that for two thousand years our Talmud has permitted both the delay of the funeral and respectful examination - including autopsies - where necessary for the purpose of honoring our dead or saving the living.
The second area of concern is what responsibility we have for burying a person's entire body. This area constitutes the Orthodox community's primary concern regarding both autopsy and organ donation. We might have thought that any objection would have been based upon the notion of k'vod ha'met ,honoring the dead, in which it would be considered desecration of the body to remove parts of it. This is not the source of their concern. We might also have thought that any Orthodox opposition would be based upon a traditional Jewish view of life after death - a view that is really quite foreign as a Jewish concept to most of us; namely, that of bodily resurrection, that we need all parts of our body to be buried with us so that we will be intact when we leave our graves sometime in the future to walk to Jerusalem and greet the Messiah. This also, surprisingly enough, is not the source of their concern.7
Instead, traditional authorities that discuss the burial of a person's entire body indicate that it is done only to prevent the ritual contamination of kohanim, members of the Jewish community's priestly class, the group that in Temple times was in charge of all the sacred rituals. In the Jewish legal tradition, although the Temple is long gone, kohanim still maintain a level of "readiness" for participation in our sacred rites. Therefore, a kohen may not come into contact with anything that has died.8 Except for a parent's funeral, they will not enter cemeteries, and unless there is absolutely no one else to do so, they are not permitted to prepare a body for burial. Jewish law has gone to great lengths to prevent kohanim from accidentally coming into contact with the dead or anything else that would render them ritually "impure." Burying a complete body ensures that a kohen will not have to worry about ritual contamination. A question that remains is, "Do all parts of the body contaminate the kohen or are there parts that do not?"
In the twelfth century, Moses Maimonides, one of the all-time greatest authorities of Jewish law, differentiated between parts of the body that render the kohen impure, and parts of the body that do not.9 Maimonides determined that internal organs do not transmit ritual impurity, and therefore, while we should not frivolously remove any internal organs, we have no obligation to bury them with the body.
Further, with the innovation of organ donation, Orthodox Jewish authorities of this century have determined "that when a part of a body is taken by a surgeon and put into a living body, it becomes part of that living body. Its status as part of the dead which needs to be buried is now void." 10 The kohen need not worry about contamination.
So if we thought that Jewish tradition opposes organ donation because the entire body is supposed to be buried intact, we now know that it is permissible by traditional Jewish law to remove parts of the body and to place them inside another human being.
The third area of concern is a general principle that the body of the dead may not be used for the benefit of the living.11 It would certainly seem clear to us that organ donation would be in direct violation of such a principle; removing part of a body from someone who has died and giving it to someone who is still living certainly appears to be for the benefit of the living. But upon close examination of the word hana'ah ... benefit, we find that the Talmud is, in fact, discussing cannibalism, which clearly is off-limits in our tradition. To save a human life by way of surgical transplantation, all Jewish authorities agree, does not fall into this category.
So if we thought that Jewish tradition opposes organ donation because the body of the dead may not be used for the benefit of the living, we now know that healing one person's illness by using organs and tissues from a body no longer living is not in violation of Jewish law.
The final area of concern is in defining the precise moment of death. This has been an important issue in Jewish tradition because, as I mentioned earlier, we are required to bury our dead as quickly as possible. For thousands of years, Jewish law has understood the moment of death as being when breathing and heartbeat have stopped.12 These are understandable criteria for past generations who, in the absence of modern technology, were limited in the resources available to them for determining when death had occurred. Today however, in an age when bodies continue to breathe and hearts continue to beat because of artificial respirators, death is now defined by the cessation of all brain activity. It is in this area alone that Orthodox Jewish law is having the greatest difficulty. Letting go of old definitions is hard; prominent Orthodox Jewish authorities have already endorsed the brain-death definition, but sections of their community have a distance yet to go.
What it all comes down to is this. By and large, the Jewish legal tradition has never opposed organ donation. For nearly two thousand years, it has laid the groundwork in favor of such actions. The Orthodox community is in the final stages of sanctioning it altogether. And the Conservative, Reconstructionist and Reform movements have supported and encouraged it for many years now.
However, despite our endorsement, even liberal Jews do not sign their donor cards. We still hang onto an ill-informed and inaccurate remnant of our collective memories. How about we begin to change that? Please ... do two things. Do them for yourself, and do them for your loved ones. Sign your donor card (it's on the back of your driver's license). And discuss as a family your desire to be an organ donor if circumstances should ever make that a possibility. Don't assume anyone knows your wishes, or that you know theirs. And understand that signing the card is not enough; our next of kin are the ones who give or withhold approval when the hospital asks for permission to use body organs and tissue. Lives may be depending on us. We need not let them down.
Patti Szuber, a 22-year old nursing student, sat one evening with her parents, Jeanne and Chester Szuber, speaking with them about her desire to become an organ donor. She wanted them to know that, if the time ever came and she could not speak for herself, she hoped that her parents would inform the hospital they could make use of Patti's body to save other lives. Then, on August 18, 1994, Patti was thrown from her car in an accident in Tennessee. Upon arriving at the hospital, she was declared dead. Because Patti had spoken with them, her family was able to relay her wishes and, less than six hours after her death, Patti's heart arrived in Michigan where it was given to a man who had been waiting four years for the lifesaving surgery that would restore his health. Amazingly, that man was Patti's own father.
Sign your donor card. And let your family know about it.
Melekh hafetz ba'khayim ... O God who delights in life ... during the High Holy Days we read, "On Rosh HaShanah it is written, on Yom Kippur it is sealed: Who shall live and who shall die?" These words have resonated across countless generations of Yom Kippur congregations, every individual in every age wondering just exactly what they mean. Help us to understand that each one of us can ensure, for someone in need of a surgical transplant, life will continue to include them. Help us to know that, for each one of us who signs our donor card and makes our wishes clear to our family, regardless of what happens to us in the coming year, we will have indeed been sealed for a blessing in the Book of Life.
1 "To Remember Me," from A 3rd Serving of Chicken Soup for the Soul (Jack Canfield and Mark Victor Hansen, page 184).
2 "All Take and No Give," Moment magazine (August 1995). 5
3 Deuteronomy 21:23.
4 Sanhedrin 46a-47a.
5 Berahot 45a.
6 Hullin 11b.
7 Ezekiel Landau, Noda Beyehudah, Vol. II, Yoreh Deah #209.
8 Leviticus 21:2ff; Shulhhan Arukh, Yoreh Deah 373.7f.
9 Yad, Hil. Tumat Hamen 2.3.
10 American Reform Responsa (CCAR), page 295.
11 Sanhedrin 47b.
12 M. Yoma 8.5; Yad, Hil. Shab. 2.19; Shulkhan Arukh, Orah Hayim 329.4.
Adapted from a High Holy Day sermon written and delivered by Rabbi Billy Dreskin, Woodlands Community Temple, White Plains, NY.